The Hospital Built Environment: What Role Might Funders of Health Services Research Play?

Appendix A: Key Informants Interviewed

• Leonard Berry, Distinguished Professor, Mays Business School, Texas A&M University.
• Rosalyn Cama, President, Cama Inc.; Chair, Center for Health Design.
• Ken Dickerman, Architect, Leo A. Daly; American Institute of Architects.
• Marie Egan, Project Manager, "OR of the Future Project," Massachusetts General Hospital; Center for Innovation at the Massachusetts Institute of Technology (CIMIT).*
• John Gosbee, Director, Patient Safety Information Systems, National Center for Patient Safety, Department of Veterans Affairs.
• Skip Gregory, Bureau Chief, Office of Plans and Construction, Agency for Health Care Administration.
• Kirk Hamilton, Architect, Watkins Hamilton Ross Architects, Inc.; Texas A&M University.
• Susan Hassmiller, Robert Wood Johnson Foundation.
• H. Scot Latimer, Vice President and National Director, Facility Planning Services, Kurt Salmon Associates.
• Derek Parker, Architect, Anshen Allen.*
• Jane Rhode, Designer, International Interior Design Association.
• John Reiling, President and CEO, St. Joseph's Community Hospital.
• Dennis Rosenbaum, Neonatologist, St. Luke's Hospital.
• Ron Smith, Architect, HOK
• Craig Zimring, Professor, College of Architecture, Georgia Institute of Technology.

* Denotes e-mail correspondence.

Appendix B: Organizations with Staff Expertise in the Built Environment

Academy of Architecture for Health (AIA)
Academy of Neuroscience for Architecture
Center for Health Design (CHD)
Center for Innovation at MIT (CIMIT)
Coalition for Health Environments Research (CHER)
Environmental Design Research Association (EDRA)
Planetree
Robert Wood Johnson Foundation (RWJF)
Salk Institute for Biological Studies

Academic Institutions

Clemson University
Georgia Institute of Technology
Texas A&M University
University of California San Diego
University of Miami
University of Madison—Wisconsin

Appendix C: The Built Environment—Determining AHRQ's Niche Interview Protocol

The Agency for Healthcare Research and Quality (AHRQ) has engaged The Lewin Group to conduct an environmental scan to help identify AHRQ's role in addressing what is and is not known about the relationships between hospital design and patient outcomes, patient safety and satisfaction, and staff safety and satisfaction. The objective of this interview is for us to gain a better understanding of:

• Your personal experiences and perceptions regarding the built environment.
• Who is leading the field in funding, conducting, disseminating, and applying research findings in the design of health facilities.
• Your insights on current areas of research focus, outcomes to date, and gaps in the available research.
• Future research directions.
• Your feedback regarding possible roles for AHRQ in supporting and disseminating research in this area.

Background / Individual Role and Experiences in the Built Environment

1. How did you become involved with research related to the impact of the built environment on the following outcomes of interest?
    Probes:
        Patient care outcomes.
        Patient safety and satisfaction.
        Staff safety and satisfaction.

2. How long have you been working in this field?
    Probes:
        Findings to date.

3. What has been the focus of your work to date?

4. How much research has been conducted on your specific-research topic/area of interest?

Building the Field of Facility Design and Outcomes, Safety, and Working Conditions

5. In your view, who are the leading researchers and experts in the field?
    Probes:
        Architects.
        Interior designers.
        Health care practitioners.
        Health system executives.
        Academicians.
        Researchers.

6. What is driving the market for hospital design and construction?
    Probes:
        Hospital errors.
        Demonstrated success of other hospitals.
        Financial incentives.

7. Are hospital administrators requesting evidence-based designs? If no, why not?

8. Is it possible to "design-out" risks and hazards in hospital design, or is there always some level of risk/hazard involved?

Dissemination of Research Findings

9. Who are the major funders for research (that inform architects, interior designers, and health systems administrators) in the field?

10. In your view, what research and/or practical applications are particularly important and to what extent are they funded?

11. What types of studies are currently being funded? (e.g., descriptive, case studies, controlled trials, natural experiments). Are the published findings peer reviewed?

12. If the research is not currently available in peer reviewed journals, where do you typically find information and research on the built environment?

13. What organizations are involved in disseminating research findings and innovative successful practices?

Implementation of Promising Practices

14. In your view, has the built environment influenced patient safety and patient and staff satisfaction? If so, in what ways? If not, why not?

15. Do existing laws and/or regulations regarding hospital design and construction impact patient safety & outcomes and staff satisfaction? If so, how?
      Probes:
          JCAHO.
          State Health Departments.

16. Can you give examples where investing in facility design and construction led to "best practices" and/or noticeable improvements in patient safety & outcomes, staff safety, or patient & staff satisfaction levels?
      Probes:
          Pebble Partners (St. Alphonsus in Boise, ID; Bronson Methodist in Kalamazoo, MI; Barbara Ann Karmanos Cancer Institute in Detroit, MI).

17. What elements are most desirable to include in designing hospitals that create therapeutic environments?
      Probes:
          Lighting.
          Color.
          Single beds.
          Way-finding systems.
          Ventilation.
          Corridor design (single versus radial).
          Other.

18. What is the business case for incorporating these elements into hospital design and construction?

19. What obstacles do hospital designers, administrators and researchers encounter in building the field of hospital design as a vehicle for improving outcomes?

20. Have you seen any unexpected outcomes emerge from research or investment in the built environment?

Areas of Future Focus in the Built Environment

21. Are there apparent gaps in the research on the built environment that are important to address (e.g., lighting and patient safety)?

22. What areas of the built environment do you see gaining momentum in the future (i.e., emerging trends)?

AHRQ: Potential Future Role and Areas of Impact

AHRQ, part of the U.S. Department of Health and Human Services, is the lead Agency charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services. The Agency consists of nine major departments including the Center for Quality Improvement and Patient Safety (CQuIPS), the Center for Outcomes and Evidence, and the Office of Communications and Knowledge Transfer.

23. AHRQ is interested in assessing its potential role in the built environment. If it was to get involved in the built environment, what do you think its priority should be? Funding new research? Disseminating what is already known about the built environment? Are there other options that you would recommend AHRQ pursue?

24. Would greater involvement by AHRQ help lift the profile of the built environment among researchers, designers, hospital administrators and other stakeholders?

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AHRQ Publication No. 05-0106-EF
Current as of October 2005

Internet Citation:

The Hospital Built Environment: What Role Might Funders of Health Services Research Play? Agency for Healthcare Research and Quality, Rockville, MD. AHRQ Publication No. 05-0106-EF, October 2005. http://www.ahrq.gov/qual/hospbuilt/

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